Medicare Part B Drug Payment

The Trump Administration is considering a radical overhaul to how physician-administered drugs are reimbursed and provided in Medicare. An Advanced Notice of Proposed Rule Making suggests a demonstration project whereby “buy-and-bill” would be eliminated entirely in half of the country and potentially put physician practices in the other half of the country underwater when they prescribe Part B drugs. New vendors with ability to limit physician choice of products for their patients would administer the proposed program.

LUGPA firmly believes that this initiative, implemented without sufficient stakeholder input, will adversely affect the care and treatment of Medicare patients with complex conditions such as cancer, macular degeneration, hypertension, rheumatoid arthritis, Crohn’s disease and ulcerative colitis as well as primary immunodeficiency diseases.


What is LUGPA’s Goal?

LUGPA is committed to ensuring appropriate patient access to drugs and believes policies of this sweeping nature should be considered by Congress, not imposed by CMS under the auspices of a demonstration project.


LUGPA’s Actions and Resources

Members of the House Doctors Caucus sent a letter to HHS Secretary Alex Azar and CMS Administrator Seema Verma requesting reconsideration of the policy that permits Medicare Advantage plans to implement step therapy procedures – a central LUGPA focus in 2019 – July 1, 2019

LUGPA Comments to CMS on International Pricing Index Model for Medicare Part B Drugs – December 31, 2018

LUGPA Comments to CMS on Proposed Medicare Part B Drug Payment Model – May 9, 2016